Healthcare Provider Details

I. General information

NPI: 1184748048
Provider Name (Legal Business Name): SAMIAT BISOLA TUMASANG DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMIAT BISOLA BROWN DPT

II. Dates (important events)

Enumeration Date: 03/18/2007
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 BRIGADE CIR
FREDERICK MD
21702-2514
US

IV. Provider business mailing address

2127 BRIGADE CIR
FREDERICK MD
21702-2514
US

V. Phone/Fax

Practice location:
  • Phone: 757-218-9831
  • Fax:
Mailing address:
  • Phone: 757-218-9831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24046
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2305204824
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: